title: Evaluation of multidimensional COPD-related subjective fatigue following a pulmonary rehabilitation programme.
abstract: BACKGROUND
  Subjective fatigue has been recognised as an important, multi-component symptom in COPD. Pulmonary Rehabilitation (PR) improves fatigue component of the Chronic Respiratory Questionnaire, a quality of life (QoL) measure. However, it is not clear if all fatigue dimensions are affected equally. This study aims to evaluate changes in subjective multidimensional fatigue among people with COPD who participated in PR.
  
  
  METHODS
  Thirty seven stable COPD patients were recruited; 23 patients (15 male) mean age 68.5 (range 49-86) yrs, mean (SD) %predicted FEV1 45.3 (19.8); completed 7 weeks of PR. Assessments (pre and post PR) consisted of the Multidimensional Fatigue Inventory (MFI-20), QoL (SGRQ), Anxiety and Depression (HADS), the London Chest Activity of Daily Living Scale (LCADL), muscle strength, incremental (ISWT) and endurance (ESWT) shuttle walk tests. The differences between pre and post PR fatigue were tested using Wilcoxon's test and relationships with other outcomes were examined using Spearman's correlation.
  
  
  RESULTS
  There were statistically significant improvements in Reduced Activity (RA) (p = 0.01), General (GF) (p < 0.01) and Physical Fatigue (PF) (p = 0.03) components of MFI-20 after PR, but there were no differences in Motivation or Mental Fatigue (p > 0.05). There were significant improvements in ISWT (p < 0.05), ESWT (p < 0.01) and muscle strength (p = 0.03). Statistically significant correlations (p < 0.05) were found between changes in GF and in both ISWT (r = -0.43) and SGRQ impact (r = 0.46); and between RA and ESWT changes (r = -0.45).
  
  
  CONCLUSIONS
  Some dimensions of fatigue in COPD are modifiable by a 7-week PR programme. Change in fatigue dimensions in COPD may be associated with a change in maximal or endurance walking distances or QoL.
authors.affiliation: Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, UK. Electronic address: lewko.agnieszka@gmail.com.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Lewko
authors.affiliation: Faculty of Science, Engineering and Computing, Kingston University, UK. Electronic address: bidgood@kingston.ac.uk.
authors.forename: Penelope L
authors.initials: PL
authors.lastname: Bidgood
authors.affiliation: Faculty of Health, Social Care and Education, St. George's University of London and Kingston University, UK. Electronic address: A.Jewell@sgul.kingston.ac.uk.
authors.forename: Andy
authors.initials: A
authors.lastname: Jewell
authors.affiliation: Kings College University, Denmark Hill Campus, London, UK. Electronic address: rachel.garrod@nhs.net.
authors.forename: Rachel
authors.initials: R
authors.lastname: Garrod
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D003863:Depression; D005221:Fatigue; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016138:Walking
keywords: COPD; Disease management; Fatigue; Pulmonary rehabilitation